Overall survival in patients with advanced melanoma (MEL) who discontinued treatment with nivolumab (NIVO) plus ipilimumab (IPI) due to toxicity in a phase II trial (CheckMate 069).

Authors

null

F. Stephen Hodi

Dana-Farber Cancer Institute, Boston, MA

F. Stephen Hodi , Michael Andrew Postow , Jason Alan Chesney , Anna C. Pavlick , Caroline Robert , Kenneth F. Grossmann , David F. McDermott , Gerald P Linette , Nicolas Meyer , Jeffrey K. Giguere , Sanjiv Agarwala , Montaser F. Shaheen , Marc S. Ernstoff , David R. Minor , April K. Salama , Matthew H. Taylor , Patrick Alexander Ott , Joel Jiang , Paul Gagnier , Jedd D. Wolchok

Organizations

Dana-Farber Cancer Institute, Boston, MA, Memorial Sloan Kettering Cancer Center, New York, NY, University of Louisville, Louisville, KY, NYU Perlmutter Cancer Center, New York, NY, Institute Gustave Roussy, Villejuif-Paris-Sud, France, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, Beth Israel Deaconess Medical Center, Boston, MA, Washington University, St. Louis, MO, Institut Universitaire du Cancer, Toulouse, France, Greenville Health System, Seneca, SC, St Luke's Cancer Center and Temple University, Bethlehem, PA, University of New Mexico Cancer Center, Albuquerque, NM, Cleveland Clinic, Cleveland, OH, California Pacific Center for Melanoma Research, San Francisco, CA, Duke University, Durham, NC, Oregon Health & Science University, Portland, OR, Bristol-Myers Squibb, Princeton, NJ

Research Funding

Pharmaceutical/Biotech Company

Background: Results from CheckMate 069 demonstrated a significant improvement in objective response rate (ORR) and progression-free survival (PFS) with NIVO+IPI vs IPI alone in treatment-naïve patients (pts) with BRAF wild-type MEL (N Engl J Med 2015;372:2006). We evaluated overall survival (OS) in pts who discontinued treatment due to toxicity in this study. Methods: Pts (N = 142) were randomized 2:1 to receive NIVO 1 mg/kg plus IPI 3 mg/kg or IPI 3 mg/kg plus placebo every 3 weeks x 4 doses, followed by NIVO 3 mg/kg or placebo, respectively, every 2 weeks until disease progression or unacceptable toxicity. The primary endpoint was ORR in pts with BRAF wild-type tumors. Secondary and exploratory endpoints included PFS and OS. A post-hoc analysis was performed to evaluate OS in pts who discontinued treatment due to toxicity. Results: At a follow-up of ≥18 months, median OS in pts who discontinued treatment was not reached with NIVO+IPI and was 11.2 months for IPI alone (Table). Similar 18-month OS rates were observed in pts who discontinued NIVO+IPI due to toxicity and in the overall treatment group (Table). Among pts who discontinued NIVO+IPI, ORR was 68% (27% achieved a complete response). Median duration of response was not reached and 21 of 30 pts (70%) remain in response. Grade 3/4 treatment-related adverse events (AEs) occurred in 55% of pts in the NIVO+IPI group vs 22% with IPI, and led to discontinuation in 30% and 9% of pts, respectively. In pts who discontinued NIVO+IPI due to toxicity, resolution rates of treatment-related select AEs ranged from 89% to 100% (40% for endocrine AEs). Efficacy updates, including 2-year OS rates, will be presented for these pts. Conclusions: These data suggest that pts who discontinue NIVO+IPI treatment due to drug toxicity derive an OS benefit similar to that observed in the overall population. Clinical trial information: NCT01927419

All randomized pts who discontinued due to toxicity
All randomized
BRAF wild-type pts
NIVO+IPI
(n = 44)
IPI
(n = 10)
NIVO+IPI
(N = 72)
IPI
(N = 37)
Median OS, months (95% CI)NR11.2 (2.2–NR)NRNR
Hazard ratio (95% CI)0.24 (0.09–0.70); P= 0.0040.56 (0.29–1.10); P= 0.089
18-month OS rate, %79.540.073.256.0

NR, not reached.

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Abstract Details

Meeting

2016 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Clinical Trial Registration Number

NCT01927419

Citation

J Clin Oncol 34, 2016 (suppl; abstr 9518)

DOI

10.1200/JCO.2016.34.15_suppl.9518

Abstract #

9518

Poster Bd #

123

Abstract Disclosures